Episode 48 Melancholy Mothers: The history of Peripartum Psychiatry

Some people say that women ~ glow ~ when they are pregnant. Or that having a baby is one of the best memories they have. But did you know 80% of women have depressive symptoms in the week following childbirth? Or that ⅛ women develop a condition called postpartum depression? Some women are even at risk for manic or psychotic episodes in the postpartum period. These conditions are so prevalent that there is a whole field of psychiatry dedicated to caring for women’s mental health during pregnancy and in the postpartum period! Join us in this episode to learn about how the field of peripartum psychiatry developed from ancient Greece, through medical times, and into the 1800s! Then we will spend some time exploring current theories behind the most common peripartum mental illnesses and discussing how obstetrics takes part in this field today.

Feminist Corner:

Obstetrics as a field is often viewed as very different from other medical and surgical specialties. In reality, it is very closely linked to other fields of medicine, especially psychiatry in this case. What are some ways that obstetricians can take part in multidisciplinary practices?

Listen to the episode, discuss these questions with friends and family, let us know what you think!

Show Notes:

Some definitions to start us off:

Peripartum: The period of time a person is pregnant, giving birth, and the time after birth lasting up to 1 year
Postpartum: The time period after birth

In this episode, we use the two terms kind of interchangeably. But to be more specific, there are three mental illnesses we are specifically speaking about today:

Baby Blue: the period lasting about a week after childbirth when people experience depressive symptoms. This usually resolves on its own without treatment
Postpartum Depression (PPD): Starting within 4 weeks of the postpartum period with depressive symptoms that require treatment
Postpartum Psychosis (PPP): Symptoms of mania, delusions, and hallucinations within the postpartum period. This is a medical emergency

Ancient History

Common ideas about PPD and PPP are rooted in other common ancient theories such as the four humuors and supposedly tracts that ancient physicians thought traveled from the uterus to the breast and then to the brain
Hippocrates reported on a case where a woman gave birth to twins and then fell into a mania that killed her two weeks later
A Greek myth about Theseus and Phaedra, detailed Phaedra becoming depressed and suicidal after childbirth
Soranus of Ephesus noted that women while nursing can become dangerous around their babies, pointing at PPP. He theorized that it was because your four humours were out of balance due to the nutritional status of the mother

The 1800s-1900s

French psychiatrist, Esquirol, advocated for equal treatment of mentally ill patients. He also studied over 90 women who experienced PPD and advocated for the correct treatment of these women
Lactional mania was a big topic in the 1800s, with multiple psychiatrists reporting cases of women having depressive or manic episodes in the breastfeeding period
Freudian influence led to theories of psychoanalysis that led people to believe that a repressed Oedipus Complex caused PPD
Louis Bictor Marce studied the social determinants of health leading to PPD in the mid 1800s and founded the field of Peripartum Psychiatry

Today

Current theories of why PPD and PPP occur are related to biology and social determinants of health
Biological factors include the changing of hormones after pregnancy, low serotonin and serotonin receptor levels, and thyroid changes
Social factors include: mode of delivery, income, social economic status, marital conflicts, sleep loss, and past medical and psychiatric history
Obsetritians and other medical specialties should be aware of the symptoms of PPD and PPP and have available screening tools, treatments, and referrals.

Sources:

Brockington, I. (2016). Suicide and filicide in postpartum psychosis. Archives of Women’s Mental Health, 20(1), 63–69. https://doi.org/10.1007/s00737-016-0675-8

Dr. Veeramuthu , & Dr M A Narayanaswamy . (n.d.). A Study of Biopsychosocial Factors Affecting Postpartum Depression. Journal of Dental and Medical Sciences, 20(7).

Loudon, I. (1988). Puerperal Insanity in the 19th Century. Journal of the Royal Society of Medicine, 81(2), 76–79. https://doi.org/10.1177/014107688808100207

Osborne, L. M. (2018). Recognizing and managing postpartum psychosis. Obstetrics and Gynecology Clinics of North America, 45(3), 455–468. https://doi.org/10.1016/j.ogc.2018.04.005

Past, present, and future of perinatal psychiatry – schulich school of … (n.d.). Retrieved April 17, 2023, from https://www.schulich.uwo.ca/psychiatry/docs/Sharma-am-keynote-Past,-Present,-Future-of-Perinatal-Psychiatry—Nov-21.pdf

Postpartum depression and addiction. Addiction Center. (2023, April 13). Retrieved April 17, 2023, from https://www.addictioncenter.com/addiction/postpartum-depression-addiction/

ROHÉ, G. E. O. R. G. E. H. (1993). Lactational insanity. JAMA: The Journal of the American Medical Association, 270(10), 1180. https://doi.org/10.1001/jama.1993.03510100030011

Skalkidou, A., Hellgren, C., Comasco, E., Sylvén, S., & Poromaa, I. S. (2012). Biological aspects of postpartum depression. Women’s Health, 8(6), 659–672. https://doi.org/10.2217/whe.12.55Tovino , S. A. (n.d.). Scientific Understandings of Postpartum Illness: Improving Health Law and Policy? . Williams Boyd School of Law.

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